Provider Demographics
NPI:1477018224
Name:KATZ, BRACHA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:BRACHA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:BRACHA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:1010 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1203
Mailing Address - Country:US
Mailing Address - Phone:917-588-7108
Mailing Address - Fax:
Practice Address - Street 1:1380 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5015
Practice Address - Country:US
Practice Address - Phone:718-879-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1OtherOTHER